2017 American Political Scene

[antimony]

Lot's of other folks didn't. Lot's of Trump voters voted for Trump who happen to have newly acquired health insurance in some of the sickest states. They voted Trump and then hoped he would leave it alone in interviews of them. Funny as how the Republicans accused Obama of creating death panels yet modifying pre-existing conditions, allowing large surcharges, and limiting Medicaid in 2020 could do just that. I suspect this will not go fast in the Senate with Rand and Cruz probably demanding total destruction in order to show their cajones for their base.

So no, if Australia is so great and it impresses Trump so much then maybe that is what he should shoot for. Therefore completely relevant.

Yes, lots of other people didn't. They should get off their asses and screw it into the Republicans in the 2018 elections and then again in 2020. Meanwhile, the Republicans have the WH, the House, the Senate, numerous governorships and state legislatures. So they bloody well get to do what they want.

If the people have chosen bags of shit, then they deserve the right to have that shit forced down their throats when their elected representatives want to.

Therefore, whatever Australia or Britain or Mongolia or Cambodia have is completely irrelevant. The American people deserve to get whatever they voted for, even if it literally kills them.

[Monash]

Irrelevant, this needs to go out and get passed quickly. There are lots of folks in trump country that have voted on this and therefore fully deserve this.

Your right, given that the Republicans in Congress have voted to remove 'O'Bama Care' without first putting together a replacement health care model of their own all those (soon to be uninsured) folks in 'Trump Country' deserve exactly what their going to get.

[zraver]

Your right, given that the Republicans in Congress have voted to remove 'O'Bama Care' without first putting together a replacement health care model of their own all those (soon to be uninsured) folks in 'Trump Country' deserve exactly what their going to get.

How do you fix a monthly premium that is 20% of your income plus a yearly deductible that is another 20% of your income? ACA insurance plans can cost a person 40% of their income before the insurance plan pays a dollar. By making insurance pay for everything and everyone it has crushed people. The combination of freebies that are not free, covering everyone and
increasing premiums and deductibles is horrid brew.

The GOP plan passed by the House is a step towards fixing the problem. Move non-elderly and non-acute heavy users of health care into high risk pools and out of the general insurance pools. As far as I know, the bill does not remove the ACA's caps on insurance plan profits and refund requirements so premiums will go down.

Forcing younger healthier people to pay for older sicker people is not "someone is coming" its wealth theft from the age group that is the most burdened by debt and lack of opportunity. ACA costs plus student debt= you'll never get out of that hole.

To make matters even worse the ACA does not achieve its stated goal. The numbers of people with insurance went up, but the number of people who could actually see a doctor remained static. Middle class people couldn't afford to use their insurance and stopped going to doctors and they were replaced by newly enrolled medicaid patients who don't have to pay anything. That has made a lot of people in middle America seething mad.

How come they work and get rewarded with taxes and insurance they don't benefit from, but a non-disabled poor person gets free healthcare?

Honestly in my opinion. 1. Move the heavy users to an income based subsidized high risk pool. Maybe reduce the enrollment age of medicare. This would freshen and increase the dues paying member pool and make it slightly healthier and so help its long term viability. 2. Get rid of any freebie that can be bought OTC for less than $30 a month. Case in point, OTC GERD meds, same strength as a prescription are 1/4th the cost. Yet people would rather bill the insurance company $96 and pay $4 than pay an extra $12 and bill the insurance company $0. 3. No free healthcare for the non-disabled adults. At least require a modest copay at a doctors office and a higher one at ER rooms (for non-emergency visits). ER visits remain one of the biggest costs in healthcare.

Even with those ideas though, nothing short of jail time is goign to force healthy people struggling with other forms of inescapable debt pony up for health insurance they won't actually need for years to come. They have kids to raise, student loan, CC ad car payments to make and dreams of adding a mortgage payment to the mix. Asking them to voluntarily impoverish themselves so that middle aged people who made bad life style choices can have cheaper healthcare is a losing argument.

Oh, I don't think single payer would fix the problem either but that is a different discussion based on different fact sets.

[astralis]

given that the ACA represents the conservative "third way" between the quasi-privatized pre-existing system and universal healthcare, the irony is that the GOP has very likely hastened the implementation of single-payer.

what the GOP is promising is simultaneously more benefits (less costly premiums, lower deductibles), coverage to anyone whom wants it regardless of pre-existing conditions, and "freedom" from any mandate for anyone whom doesn't. all with less government intervention/cost.

think all they're missing is a chicken in every pot and a magical pony.

there's several ways this places out: either this dies another death in the Senate (highest likelihood) while the Dems use this to pummel vulnerable GOP House members, or-- probably far worse for the GOP in the long run-- this succeeds, and the result will be millions losing coverage, that sad $8 billion in risk-pool money vaporizing overnight, and a far weaker market as insurance companies bleed like a stuck pig.

option 2 would probably mean several massive wave elections in '18 and '20, and the idea that a triumphant Democratic Party would go for simply a reinstatement of the ACA is laughable.

but as i said, it's not likely. there's going to be another huge wave of GOP recriminations when the CBO score comes out, and Senate Republicans will almost certainly respond to it by making changes that the Freedom Caucus part of the House GOP will not accept. after all, this revised AHCA is actually MORE conservative than the initial AHCA of the 17% public approval.

this really feels more like a political play by Preibus and Ryan to convince Trump that they're not worthless and can get SOMETHING done, even if that something isn't, ah, particularly useful for their party. Trump's initial instinct to shut down the initial healthcare play was the right one; doing this again now will just force another political embarrassment later on and eat up more of the legislative calendar.

good.

[zraver]

Obamacare has entered its death spiral. Trump was right when he said he should have let it fail and let the Dems take the fall. The only way to save private healthcare in the US is to make the pool healthier. Since you can't force healthy people to pay an extra 20% tax on their income=- move sicker people out of the pools. Chronic cases need to be in a separate pool.

[Monash]

Obamacare has entered its death spiral. Trump was right when he said he should have let it fail and let the Dems take the fall. The only way to save private healthcare in the US is to make the pool healthier. Since you can't force healthy people to pay an extra 20% tax on their income=- move sicker people out of the pools. Chronic cases need to be in a separate pool.

And those 'pools are paid for by whom exactly? Every Western nation faces exactly the same problem and the solution is always the same. A tacit agreement that the young and healthy support the old and sick in the sure and certain knowledge that as they themselves will progress up that queue as they age into the latter category into the former. There are no easy solutions, if there were some one would have adopted them by now. The USA is the only advanced economy in the world that has not adopted some form of universal health care system, while managing at the same time to produce worse health outcomes for its citizens than any of it's contemporaries I can think of. As a nation you send more on health care per capita than virtually any nation on the planet while at the same time achieving worse results, how is that an acceptable outcome.

[astralis]

^ precisely, the question is simply whom ends up paying.

BTW, the CBO analysis shows both the ACA being stable in the long-term as well as the immediate effect of the AHCA:

The legislation would tend to increase average premiums in the nongroup market prior to
2020 and lower average premiums thereafter, relative to projections under current law. In
2018 and 2019, according to CBO and JCT’s estimates, average premiums for single
policyholders in the nongroup market would be 15 percent to 20 percent higher than under
current law, mainly because the individual mandate penalties would be eliminated,
inducing fewer comparatively healthy people to sign up.

in the medium term, premiums are somewhat moderated:

Starting in 2020, the increase in average premiums from repealing the individual mandate
penalties would be more than offset by the combination of several factors that would
decrease those premiums: grants to states from the Patient and State Stability Fund (which
CBO and JCT expect to largely be used by states to limit the costs to insurers of enrollees
with very high claims); the elimination of the requirement for insurers to offer plans
covering certain percentages of the cost of covered benefits; and a younger mix of
enrollees. By 2026, average premiums for single policyholders in the nongroup market
under the legislation would be roughly 10 percent lower than under current law, CBO and
JCT estimate.

but the moderation in overall average costs is done by re-balancing the costs:

Under the legislation, insurers would be allowed to generally charge five times more for
older enrollees than younger ones rather than three times more as under current law,
substantially reducing premiums for young adults and substantially raising premiums for
older people.

the overall effect of the proposed Republican legislation is pretty funny politically because the loss of benefits hits red states AND the elderly (who lean GOP) the hardest.

[antimony]

Obamacare has entered its death spiral. Trump was right when he said he should have let it fail and let the Dems take the fall. The only way to save private healthcare in the US is to make the pool healthier. Since you can't force healthy people to pay an extra 20% tax on their income=- move sicker people out of the pools. Chronic cases need to be in a separate pool.

Here is a question: Why do we need to save private healthcare? Why is the focus on that instead of better healthcare?

[antimony]

there's several ways this places out: either this dies another death in the Senate (highest likelihood) while the Dems use this to pummel vulnerable GOP House members, or-- probably far worse for the GOP in the long run-- this succeeds, and the result will be millions losing coverage, that sad $8 billion in risk-pool money vaporizing overnight, and a far weaker market as insurance companies bleed like a stuck pig.

option 2 would probably mean several massive wave elections in '18 and '20, and the idea that a triumphant Democratic Party would go for simply a reinstatement of the ACA is laughable.

Which is exactly why this absolutely needs to pass

[Doktor]

Here is a question: Why do we need to save private healthcare? Why is the focus on that instead of better healthcare?

Because "one choice" never ends good.

[antimony]

Because "one choice" never ends good.

How are Australia, UK, Canada doing?

[zraver]

How are Australia, UK, Canada doing?

Long wait times, poor cancer outcomes, limited drug choices, almost no innovation, incredibly long wait times to see specialists.... Great places to be if you need urgent trauma care, not so great if you have a chronic illness. Well other than the UK, even trauma care there is failing. To many users, too little money.... even with the destruction of the military there isn't enough money to satiate the NHS. BTW, that also describes the US VA system. The federal government has already proven it can't run healthcare.

And those 'pools are paid for by whom exactly? Every Western nation faces exactly the same problem and the solution is always the same. A tacit agreement that the young and healthy support the old and sick in the sure and certain knowledge that as they themselves will progress up that queue as they age into the latter category into the former. There are no easy solutions, if there were some one would have adopted them by now. The USA is the only advanced economy in the world that has not adopted some form of universal health care system, while managing at the same time to produce worse health outcomes for its citizens than any of it's contemporaries I can think of. As a nation you send more on health care per capita than virtually any nation on the planet while at the same time achieving worse results, how is that an acceptable outcome.

Monash, by moving the chronic cases to a separate government subsidized pool the costs are more evenly spread across those who are older but not yet retired becuase they have the highest earnings and so pay the most taxes. Directly taxing the least economically advantaged group in order to pay for the healthcare of wealthier groups is immoral. It crushes their ability to build wealth and is a regressive tax that is utterly evil.

Secondly, looking at life expectancy in the US vs Europe is misleading. Until recently the difference between immigration levels between the US and Europe meant we were taking in a lot of sicker people and are not a mono-bloc population that is racially homogeneous. Lets see where Europe is in 20 years with the wave of refugees and North Africans significantly alters the demographic breakdown of the continent.

Europe was able to build its socialist paradise on US largess. We paid to keep Europe safe from the Soviets, let Europe leach away our gold reserves, paid to rebuild the trains, roads and factories of a devastated continent. Modern Europe was built with US dollars. Europe wasn't enlightened, it was sheltered.

[Monash]

Long wait times, poor cancer outcomes, limited drug choices, almost no innovation, incredibly long wait times to see specialists.... Great places to be if you need urgent trauma care, not so great if you have a chronic illness. Well other than the UK, even trauma care there is failing. To many users, too little money.... even with the destruction of the military there isn't enough money to satiate the NHS. BTW, that also describes the US VA system. The federal government has already proven it can't run healthcare.

Sorry but no. 'Australia-among-world-leaders-for-cancer-survival'

https://www.cancerinstitute.org.au/a...ancer-survival

And for a more general comparison of how our health care systems stack up in terms of costs and outcomes see below. The short answer by the way is basically summarized in the chart I posted above. Whatever the 'evils' of universal health care may be ours produces consistently better outcomes across a broad range of medical services. And yes there are long wait times for some surgical interventions (depending on specially) but those are prioritized on a needs basis i.e triaged.

As for 'limited choice of drugs' our health system requires that drug companies produce clinical evidence that a new drug produces superior clinical outcomes before it will be subsidized for public use. (FYI the Drug companies hate this) Beyond that there's no real issue.

http://www.nationmaster.com/country-...-States/Health

[Guest]

Yes, lots of other people didn't. They should get off their asses and screw it into the Republicans in the 2018 elections and then again in 2020. Meanwhile, the Republicans have the WH, the House, the Senate, numerous governorships and state legislatures. So they bloody well get to do what they want.

If the people have chosen bags of shit, then they deserve the right to have that shit forced down their throats when their elected representatives want to.

Therefore, whatever Australia or Britain or Mongolia or Cambodia have is completely irrelevant. The American people deserve to get whatever they voted for, even if it literally kills them.

I think you will find it is the American People that run the U.S. and that a U.S. President as powerful as he might be still is nothing in comparison to the will of the American people.

Trump might sound a bit crazy to some but he is going about things as a business man would as example.....for years and years many nations have benefited from massive American Military protection.

These nations especially the Europeans pay very little of their share for their own protection yet complain constantly about the massive U.S. Military presence in their own nations.

Trump went and said..."OK....you don't want us we will simply leave and your own your own but if you DO want us they YOU will have to start paying more for our protection!"

There was a LOT of European Leaders wgo said right at that point....."OH CRAP!! We can't protect ourselves without the U.S......Uhhhh.....so President Trump....how much more do we have to pay?"

LOL!!

A.M.

[antimony]

Long wait times, poor cancer outcomes, limited drug choices, almost no innovation, incredibly long wait times to see specialists.... Great places to be if you need urgent trauma care, not so great if you have a chronic illness. Well other than the UK, even trauma care there is failing. To many users, too little money.... even with the destruction of the military there isn't enough money to satiate the NHS. BTW, that also describes the US VA system. The federal government has already proven it can't run healthcare.

Your metrics of choice (wait times and consumption of medical technology), ignore the fact that US lags in healthcare outcomes severely compared to OECD nations. Also, despite spending more on health care, Americans have fewer hospital and physician visits. Meanwhile, private spending on health care is highest in the U.S. Interestingly, U.S. public spending on health care is high, despite covering fewer residents. This is without including tax exclusion for employer-sponsored health insurance (amounting to about $250 billion each year).

And yet, the US lags behind in life expectancy, infant mortality, obesity, presence of chronic ailments. Here is what was depressingly interesting, the Institute of Medicine found that poorer health in the U.S. was not simply the result of economic, social, or racial and ethnic disadvantages—even well-off, nonsmoking, nonobese Americans appear in worse health than their counterparts abroad.

http://www.commonwealthfund.org/publ...al-perspective

Secondly, looking at life expectancy in the US vs Europe is misleading. Until recently the difference between immigration levels between the US and Europe meant we were taking in a lot of sicker people and are not a mono-bloc population that is racially homogeneous. Lets see where Europe is in 20 years with the wave of refugees and North Africans significantly alters the demographic breakdown of the continent.

Ah yes, the blacks and browns, because of whom we cannot have nice things like good Healthcare, as articulated so elegantly by Joe Walsh.

Apparently Canada and UK do not have diverse populations. Ali Velshi is actually too nice with this pathetic moron.